Anthem Blue Cross and Blue Shield New Hampshire Prior Authorization Form: A Step-by-Step Guide

‍Introduction

Navigating the prior authorization process can be a complex task for healthcare providers. For Anthem Blue Cross and Blue Shield (BCBS) New Hampshire members, understanding the proper procedure for submitting a prior authorization form is essential for timely service and approval. This step-by-step guide will walk you through the process of completing and submitting the Anthem BCBS New Hampshire prior authorization form, ensuring a smooth approval process and minimizing delays in patient care.

What is Prior Authorization?

Prior authorization is a process in which healthcare providers must obtain approval from the insurance company before administering specific treatments, medications, or services. For Anthem Blue Cross and Blue Shield New Hampshire, prior authorization is required for a variety of medical services, from imaging procedures to specialty medications. The process ensures that the requested service is medically necessary, covered under the plan, and meets the insurer’s criteria.

When is Prior Authorization Required?

Anthem BCBS New Hampshire requires prior authorization for several services, including, but not limited to:

• Advanced imaging (MRI, CT scans, PET scans)
• Specialty medications
• Durable medical equipment (DME)
• Physical therapy and rehabilitation services
• Home healthcare services
• Specialty surgeries and procedures

For certain high-cost procedures and treatments, obtaining prior authorization is mandatory before the provider can proceed with care.

Step-by-Step Guide to Completing the Anthem Blue Cross and Blue Shield New Hampshire Prior Authorization Form

Step 1: Download the Prior Authorization Form

Where to get it

Step 2: Provide Patient Information

Ensure that you fill in accurate patient details, including:

• Full name
• Date of birth
• Member ID number
• Patient’s contact information This step is crucial as missing or incorrect information can lead to delays in processing the request.

Step 3: Fill in Provider Information

The healthcare provider submitting the authorization request must include the following:

• Provider’s full name and NPI number (National Provider Identifier)
• Practice or hospital name
• Contact information (phone, fax, and email)
• Specialty of the provider Accurate provider information is essential to prevent denials based on misidentification.

Step 4: Specify the Requested Service or Procedure

Specify the medical service, procedure, or medication requiring approval. Be sure to include:

• CPT or HCPCS codes (for procedures)
• ICD-10 codes (for diagnosis)
• Duration and frequency (if applicable)
• A detailed description of the service being requested This information is crucial for Anthem to evaluate the necessity and appropriateness of the treatment.

Step 5: Justify Medical Necessity

In this section, you will need to provide supporting documents to demonstrate that the requested service is medically necessary. Common documents to include are:

• Medical history and progress notes
• Laboratory or diagnostic test results
• Treatment plans and expected outcomes
• Peer-reviewed literature (if applicable) The more comprehensive your documentation, the higher the chances of approval.

Step 6: Submit the Form

Once completed, you can submit the prior authorization form via:

• Fax: Send the completed form to the designated fax number on the form.
• Online Portal: Providers can submit the request through the Anthem BCBS New Hampshire online portal.
• Phone: For urgent requests, you can contact Anthem’s customer service for immediate assistance.

Step 7: Track Your Request

After submitting your prior authorization request, you can track its status through:

• Anthem’s provider portal (where you can check approval status and receive updates)
• Phone or fax notifications from Anthem for any additional documentation or approvals
• Customer service: Contact Anthem BCBS New Hampshire for updates on your request

Common Reasons for Prior Authorization Denials

To avoid delays, ensure that the following are correct:

• Incomplete or inaccurate patient and provider information: Double-check that all fields are filled out correctly.
• Insufficient medical documentation: Ensure that all supporting documents are provided.
• Non-compliance with Anthem’s coverage criteria: Verify that the request aligns with Anthem BCBS New Hampshire’s policies.
• Late submission: Always submit requests well within the required timeframe to avoid processing delays.

How Long Does Prior Authorization Take?

The typical processing time for Anthem BCBS New Hampshire prior authorization requests is as follows:

• Routine requests: Usually processed within 5-7 business days.
• Urgent requests: Can be expedited within 24-48 hours, depending on the urgency of the case.

Conclusion

Navigating the Anthem Blue Cross and Blue Shield New Hampshire prior authorization process can be straightforward if you follow the proper steps. By ensuring that all necessary information is provided, submitting the required documentation, and following up on your request, you can reduce the risk of delays and increase the chances of timely approval. If you have further questions or need assistance with the process, don't hesitate to contact Anthem BCBS New Hampshire’s provider support for guidance.

For more information, visit the Anthem BCBS New Hampshire Prior Authorization page or reach out to their customer service team.

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